Opioids

Opioids are a class of drugs that act on the opioid receptors within the body. These receptors are primarily in the brain and spinal cord; however, they can be in other parts of the body, including the digestive and respiratory tracts. Some opioids are available via prescription, such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), and codeine. The illegal drug heroin is also an opioid. Opioids are designed (naturally and/or synthetically) to mimic the effects opium. Opium is a substance derived from the opium poppy plant. Like opium, opioids have pain-relieving properties. Prescription opioids are often used after surgical procedures or for serious injuries that cause acute (short-term) pain. In addition to their ability to decrease pain, opioids also impact other receptors in the body that influence our emotions, including receptors that control pleasure. Because of this, opioids can become addictive.1,2

In recent years, the number of opioid prescriptions written has increased dramatically, helping pave the way for their widespread use. This increase in availability of opioids and their inherent possibility for misuse by those trying to achieve euphoria or “get high”, has led to the current “opioid crisis” or “opioid epidemic” that dominates the news today. In order to combat the opioid crisis, as well as to prevent additional individuals from becoming addicted to these drugs, providers are encouraged to only prescribe opioid medications when absolutely necessary, and to closely monitor individuals taking them. Following this trend, prescribing opioids for the treatment of chronic (long-term) pain, like in the case of endometriosis, has become discouraged.1,2

What are the ingredients in opioids?

The active ingredients in an opioid can vary based on the drug itself. Although all of these active ingredients act in a similar manner, the way they’re designed, their chemical properties (such as if they are synthetic, natural, or both), and the time it takes for them to cause an effect can all be different. Common opioid active ingredients include:

Hydrocodone (Vicodin)

Oxycodone (OxyContin, Percocet)

Morphine

Oxymorphone (Opana)

Codeine

Fentanyl1

How do opioids work?

Opioids act on opioid receptors in the brain and spinal cord which can alter the pain-response pathway. This leads to a decrease in the perception of pain. In addition, opioids act on other receptors in the body that impact our emotions and our pleasure sense. Opioids increase the release of a chemical called dopamine, which is a compound that makes us feel happy and that is involved in our reward response. All of these factors can lead to a sense of euphoria, which is often considered the “high” feeling that accompanies opioid use. However, taking too much of an opioid can have life-threatening implications, as opioids have the potential to affect other aspects of our body. As an example, too large of a dose can severely slow or stop breathing (called respiratory depression), which can lead to death.1,2

Opioid overdoses can be reversed by a drug called naloxone if addressed quickly enough. Due to the current opioid crisis and the staggering number of overdoses each year, emergency medical responders often carry naloxone. Naloxone can be injected or given as a nasal spray.1,3

The opioid crisis and why opioids are not recommended for endometriosis
As mentioned, opioids can be incredibly addicting due to their pain relieving and euphoria-producing properties. The chance of addiction increases with the dosage of opioid, time of usage, and a history of other drug or alcohol abuse issues. Despite this, it is still possible for individuals prescribed opioid medication for a short time or for severe, acute pain to become addicted. Being addicted means that an individual has a compulsive need to use and seek out a substance. Individuals who become addicted to opioids often feel uncomfortable when not taking the drug (referred to as drug dependence) and they often experience a diminished effect at their original dosage of medication (called developing tolerance). When an individual becomes tolerant, they need more of the drug to experience the same original effect, which further fuels dependence and addiction.1

Since legal opioids need to be prescribed by a physician, and more physicians are being increasingly watchful over the individuals they prescribe opioids for, it’s probable that an addicted individual who was once prescribed an opioid might get turned down by their provider when its usage is no longer beneficial. When this happens, the addicted individual may seek out other options to satisfy their addiction, such as buying or using prescription opioids that are not prescribed to them, or even turning to heroin, the illegal street drug. This cycle has increased in severity and frequency in the United States as more individuals are exposed to and become addicted to opioids. This has prompted the U.S. Food and Drug Administration to make a public commitment to assisting in the epidemic by decreasing exposure to opioids, preventing new addictions, supporting those who are currently addicted or who have a history of addiction, and fostering the development of new, non-addictive pain medications.1,4

As providers are becoming more aware of the opioid crisis and are working to prescribe these only when necessary, their use for long-term pain relief, or chronic pain relief, is decreasing. This is in effort to decrease the amount of time opioids are used for, and thus, to decrease the probability of addiction. Since endometriosis pain is often long-term or chronic pain, opioids are not recommended.

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Misuse of Prescription Drugs. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused. Published January 2018. Accessed April 25, 2018.

Misuse of Prescription Drugs. National Institutes of Health: National Institute on Drug Abuse. https://www.drugabuse.gov/drugs-abuse/opioids. Accessed April 25, 2018.

Drug Overdose Deaths in the United States, 1999-2016. Centers for Disease Control and Prevention.

https://www.cdc.gov/nchs/products/databriefs/db294.htm. Published December 2017. Accessed April 25, 2018.

Opioid Medications. U.S. Food and Drug Administration. https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm337066.htm. Published April 23, 2018. Accessed April 25, 2018.